As the director of the perioperative surgical home (PSH) at Henry Ford Health System, in Detroit, Gary Loyd, MD, has helped to build a comprehensive PSH program that guides patients through the entire surgical experience, from the decision to undergo surgery to discharge and beyond. What started at ground level with a group of 30 providers has grown, in less than a year, to 169 volunteers working on seven service lines.
At the American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference, Dr. Loyd shared his insights on how best to develop an effective PSH model of care.
“The number one thing that I’ve learned is that the PSH must be collaborative for it to work,” Dr. Loyd said. “You can have success with limited resources, but you’re not going to be successful as a committee.”
To do things collaboratively, he explained, it’s crucial that everyone who is going to be touching the patient has an equal voice throughout the process in producing the strategic plans. In other words, the onus of development extends beyond anesthesiology and surgery, encompassing numerous interdisciplinary and interprofessional groups.
“One of our greatest cheerleaders—and the person that patients listen to most—is the nutritionist on the team. We also have internists and hospitalists that help with the process, and our physical therapist for hips and joints is a very strong voice and a big advocate,” said Dr. Loyd, who added that nurses also should be vocal leaders.
“With the help of 14 patient advocates, we are working on a patient education portal that’s from the patient’s standpoint,” he said. “This will include information that clinicians want patients to know, of course, but also information that patients and caregivers want to know.”
According to Dr. Loyd, the PSH model begins with a leadership triad of anesthesiologist, surgeon and hospital executive. Active involvement of the C-suite is essential for a healthy PSH program, he said, and the more senior the executive, the better. Having a surgeon with a voice in the system will also improve efficiency. “If I were starting over, I would make sure that I had as high a C-suite executive as I could get. I would also love to have a surgeon who has drunk the Kool-Aid and takes a full leadership role,” Dr. Loyd said, referring to the dangers of peer pressure.
After the triad has been established, leadership from nursing is a top priority, especially concerning patient follow-up postoperatively. “One of the biggest complaints we get from patients is the lack of follow-up after discharge, which is why home health care and SNF [skilled nursing facility] management are part of the model as well,” Dr. Loyd said.
Each PSH line also has its own surgeon–anesthesia dyad champions. While Dr. Loyd makes it a point not to micromanage individual PSH lines, finding these champions to begin with can be challenging.
“I work with anesthesia every day, so I was able to choose those leaders easily, but finding the right surgeon champions is difficult,” said Dr. Loyd, who emphasized that it all boils down to collaboration. “You have to have a common purpose for effective collaboration; you have to combine individual strengths; and you have to have trust.”
Having just added stroke to existing PSH lines, and with plans for a cath lab and anatomic pathology lab, the program is growing rapidly. “It’s been only 10 months since we finished our strategic plan, but we’ve accomplished a huge amount since then. We’re not at the Promised Land yet, but we’re getting there,” Dr. Loyd concluded.
Peggy Naas, MD, MBA, a physician volunteer in Minneapolis and former chief medical officer of health care performance improvement at Vizient, noted that physicians looking to start a PSH program at their institutions may not have access to the same resources. “For providers who are just starting and don’t have three pages of signed commitments from the C-suite, what would be your advice?”
“We tackled this on a systems level at Henry Ford, but you can make this work at a small place just as easily,” Dr. Loyd said. “The important thing is to start small and make sure that you pull a collaborative team together. You’ve got to get your administrative personnel on board and have a committed triad.
“Huge results are possible with limited resources,” Dr. Loyd continued, “but you’ve got to find the right people, build trust, create a strategic plan so you know where you’re going to end up, and have a road map to get there. That road is going to change as you go along, and there will be barriers, but you’ll learn how to navigate and get through to the end. It’s a wonderful, rewarding experience.”